Provider Demographics
NPI:1013190552
Name:WITT, COURTNI L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNI
Middle Name:L
Last Name:WITT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6911
Mailing Address - Country:US
Mailing Address - Phone:515-233-5645
Mailing Address - Fax:515-232-3537
Practice Address - Street 1:640 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6911
Practice Address - Country:US
Practice Address - Phone:515-233-5645
Practice Address - Fax:515-232-3537
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20630OtherLICENSE NUMBER